title: Surgical conversion after thoracic endovascular aortic repair.
abstract: OBJECTIVE
  Improved early and late outcomes of thoracic endovascular aortic repair compared with open repair have changed the therapeutic paradigm of thoracic aortic lesions. However, rare but serious complications due to device failure or adverse events may occur, requiring conversion to open repair.
  
  
  METHODS
  In our experience, 186 patients underwent thoracic endovascular aortic repair. Seven of these patients (3.7%) required open repair because of 3 retrograde type A dissections, 1 thoracic stent-graft collapse, 1 aneurysm enlargement without endoleak, 1 aortoesophageal fistula, and 1 stent-graft infection. All patients but 1 underwent surgical repair using cardiopulmonary bypass. Four stent-grafts were totally removed, and 3 endografts were left in situ. Three patients underwent supracoronary ascending aorta replacement via a sternotomy. Three patients underwent a descending aortic replacement via a left thoracotomy. One patient was treated by ligation of the aortic arch, ascending to supraceliac abdominal aorta bypass, and stent-graft explantation.
  
  
  RESULTS
  Thirty-day mortality was 28%. Four patients had an uneventful postoperative course. One patient was treated for postoperative sternitis. Two patients with stent-graft infections died of multiorgan failure in the early postoperative course. No stroke, paraplegia, or renal failure occurred. With a mean follow-up of 21.4 months (range, 2-60 months), 5 patients had no adverse events.
  
  
  CONCLUSIONS
  Complications due to device failure or adverse events may occur after thoracic endovascular aortic repair, requiring conversion to open repair. Our experience suggests that in some clinical or anatomic situations, caution should be recommended when offering endovascular procedures to patients with thoracic aortic diseases. Open conversion can be performed with encouraging results by a team experienced in the management of thoracic aortic diseases. With the increasing use of thoracic endovascular aortic repair, more patients will present with indications of surgical conversion.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France. ludoviccanaud@hotmail.com
authors.forename: Ludovic
authors.initials: L
authors.lastname: Canaud
authors.forename: Pierre
authors.initials: P
authors.lastname: Alric
authors.forename: Thomas
authors.initials: T
authors.lastname: Gandet
authors.forename: Bernard
authors.initials: B
authors.lastname: Albat
authors.forename: Charles
authors.initials: C
authors.lastname: Marty-Ané
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Berthet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome